BLD2020-1082+City_Application+10.12.2020_12.07.21_PM°s ` "`�o BUILDING PERMIT
CEIVED APPLICATION
ct 14 2020 Development Services
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DEVEILOFlhf€D7:?HIRVIe;bie N /Edmonds, WA 98020
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O DEPARTMENT 425.771.0220
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For handouts, submittal requirements go to: www.edmondswa.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 386 SUNSET AVE N, EDMONDS, '
Parcel: 27032400204200
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: THALIA MOUTSANIDES
Mailing Address: 386 SUNSET AVE N
City/state/zip: EDMONDS/WA/98020
Phone #: 425-672-1204
Email: thaliasdm@comcast.net
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes No
I own, reside in, or will reside in the completed structure. This
installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange according to RCW
18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Jacob Strobl
Mailing Address: 3923 N 31 st St
City/State/Zip: Tacoma/ WA/ 98407
Phone #: 206-661-3622
E-mail: jacob@strobldesign.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: J�/ers Gonstruction, Inr-
Mailing Address: 4418 128th PI SE
City/State/Zip: Everett/ WA/ 98208
Phone #: 425-328-7849
E-mail: j9emyers-onstructoon@comcast,net
STATE UBI #: 602 516 739
CITY OF EDMONDS BUSINESS LICENSE #: NR-020577
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
JOEMYMC951 PP - 10/20/2021
Office Use Only
FP
ermit#: BLD2020-1082
TYPE OF
Details
❑ Accessory Structure/
Addition
❑
Detached Garage
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
❑ Remodel
New Commercial/Mixed Use
❑ Re -Roof
❑ Signs
Tank
❑ Tenant Improvement
Other
replace front walkway
& front porch at existing
Remodel Permit fees are based on: location.
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:
PROPOSED.. FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished ❑
1st Floor, scl ft:
2nd Floor, scl ft:
Garage/Carport:, scl ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
Replace existing front walkway at existing location. Replace existing
front porch. Existing location to remain no new impervious area.
Total replaced impervious area 172 sf
I certify that the information I have provided on this form/application is true,
correct and complete, and that I am the property owner or duly authorized
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: Jacob Strobl
Signature: Date 10/12/2020
COMMERCIALGENERAL
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes❑ No❑
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other:
COUNTSGAS/FUIEL CONNECTION d or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated or re piped)
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum
Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y❑/ N❑
PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver❑
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.